The benefits and threats of blockchain technology in healthcare: A scoping review

Benchmarking Sweden's Digitalization Transformation Strategy-Is It a Good Fit for the UAE?

Background: The ongoing revolution in health care, driven by wearable technology, virtual reality, and the Internet of Things, is reshaping both health care operations and our daily lives. This digital transformation ensures broader access to health care options, fosters patient-centered care and affects both health care institutions and individuals. In Sweden, health care is undergoing a digital shift, with initiatives like personal health management, remote monitoring, and virtual care enhancing patient involvement. This article reviews Sweden's health care digital transformation and compares it with the United Arab Emirates (UAE's) initiatives to assess viability. Methods: Using systematic literature review methods, databases from 2011 to 2023 were searched, supplemented by reference lists. Results: Database searches identified 761 records. A total of 480 articles were screened on basis of title and abstract, yielding 184 that were assessed for eligibility, leading to 40 academic studies to be included and 12 grey literature. Conclusions: The findings highlight Sweden's success in empowering patients through enhanced connectivity with clinical teams, knowledge sharing, and care management. However, due to contextual differences, the UAE should not blindly replicate Sweden's strategy. In conclusion, Sweden's efforts have positively engaged patients in health care, but challenges such as emerging technologies, demographic shifts, and budget constraints persist. Proactive planning and adaptation are crucial, with lessons applicable to the UAE market. Establishing a clear regulatory framework for digital care is imperative for future resilience.

Exploring the Potential of Artificial Intelligence as a Facilitating Tool for Formulation Development in Fluidized Bed Processor: a Comprehensive Review

This in-depth study looks into how artificial intelligence (AI) could be used to make formulation development easier in fluidized bed processes (FBP). FBP is complex and involves numerous variables, making optimization challenging. Various AI techniques have addressed this challenge, including machine learning, neural networks, genetic algorithms, and fuzzy logic. By integrating AI with experimental design, process modeling, and optimization strategies, intelligent systems for FBP can be developed. The advantages of AI in this context include improved process understanding, reduced time and cost, enhanced product quality, and robust formulation optimization. However, data availability, model interpretability, and regulatory compliance challenges must be addressed. Case studies demonstrate successful applications of AI in decision-making, process outcome prediction, and scale-up. AI can improve efficiency, quality, and cost-effectiveness in significant ways. Still, it is important to think carefully about data quality, how easy it is to understand, and how to follow the rules. Future research should focus on fully harnessing the potential of AI to advance formulation development in FBP.

[Blockchain in health: Transforming security and clinical data management]

INTRODUCTION

Technological advances continue to transform society, including the health sector. The decentralized and verifiable nature of blockchain technology presents great potential for addressing current challenges in healthcare data management.

DISCUSSION

This article reports on how the generalized adoption of blockchain faces important challenges and barriers that must be addressed, such as the lack of regulation, technical complexity, safeguarding privacy, and economic and technological costs. Collaboration between medical professionals, technologists and legislators is essential to establish a solid regulatory framework and adequate training.

CONCLUSION

Blockchain technology has the potential to revolutionize data management in the healthcare sector, improving the quality of medical care, empowering users, and promoting the secure sharing of data, but an important cultural change is needed, along with more evidence, to reveal its advantages in front of the existing technological alternative.

Applications of Blockchain-Based Technology for Healthcare Devices Post-market Surveillance

The volume of data analysis for medical device post-market surveillance (PMS) has increased dramatically in recent years. It is the more stringent and intricate regulatory criteria of the health authorities that are meant to improve the medical device safety review. As regulators scrutinize device safety more closely, proactive approaches to PMS processes are becoming crucial. To solve some of the issues brought on by this shifting regulatory landscape, new technologies have been investigated. This study envisages the technical features of blockchain technology (BCT) and its role in enhancing the PMS for medical devices. To address the aforementioned challenges, our model involves the establishment of a secure, permissioned blockchain for PMS data management, utilizing a proof-of-authority consensus mechanism. This blockchain framework will exclusively permit a carefully vetted and designated set of participants to validate transactions and record them in the PMS data ledger. The utilization of BCT holds the potential to introduce enhanced efficiency and provide several advantages to the various stakeholders involved in the PMS procedure, including its potential to support emerging regulatory efforts.

CardioVerse: The cardiovascular medicine in the era of Metaverse

The recent pandemic launched an acceleration in adopting telemedicine by cardiovascular health and triggered the flourishing of technological advancements, such as the metaverse, which is a novel interactive mix of digital worlds that leverages augmented reality with virtual reality. The CardioVerse represents a theoretical term for the embracement of the metaverse by cardiovascular medicine, encompassing the endless possibilities as well as the challenges that it holds and introduces new dimensions to disease education, prevention and diagnosis. Its applications are numerous, notably in enhancing medical visits, assisting cardiovascular interventions and reshaping the way medical education is provided. Although obstacles are expected in diverse domains such as security, technical, legislative and regulatory, the utilization of non-fungible tokens as a security asset for patient data appears as potential solution.

A systematic review of privacy-preserving methods deployed with blockchain and federated learning for the telemedicine

The unexpected and rapid spread of the COVID-19 pandemic has amplified the acceptance of remote healthcare systems such as telemedicine. Telemedicine effectively provides remote communication, better treatment recommendation, and personalized treatment on demand. It has emerged as the possible future of medicine. From a privacy perspective, secure storage, preservation, and controlled access to health data with consent are the main challenges to the effective deployment of telemedicine. It is paramount to fully overcome these challenges to integrate the telemedicine system into healthcare. In this regard, emerging technologies such as blockchain and federated learning have enormous potential to strengthen the telemedicine system. These technologies help enhance the overall healthcare standard when applied in an integrated way. The primary aim of this study is to perform a systematic literature review of previous research on privacy-preserving methods deployed with blockchain and federated learning for telemedicine. This study provides an in-depth qualitative analysis of relevant studies based on the architecture, privacy mechanisms, and machine learning methods used for data storage, access, and analytics. The survey allows the integration of blockchain and federated learning technologies with suitable privacy techniques to design a secure, trustworthy, and accurate telemedicine model with a privacy guarantee.

BioChainReward: A Secure and Incentivised Blockchain Framework for Biomedical Data Sharing

In the era of digital healthcare, biomedical data sharing is of paramount importance for the advancement of research and personalised healthcare. However, sharing such data while preserving user privacy and ensuring data security poses significant challenges. This paper introduces BioChainReward (BCR), a blockchain-based framework designed to address these concerns. BCR offers enhanced security, privacy, and incentivisation for data sharing in biomedical applications. Its architecture consists of four distinct layers: data, blockchain, smart contract, and application. The data layer handles the encryption and decryption of data, while the blockchain layer manages data hashing and retrieval. The smart contract layer includes an AI-enabled privacy-preservation sublayer that dynamically selects an appropriate privacy technique, tailored to the nature and purpose of each data request. This layer also features a feedback and incentive mechanism that incentivises patients to share their data by offering rewards. Lastly, the application layer serves as an interface for diverse applications, such as AI-enabled apps and data analysis tools, to access and utilise the shared data. Hence, BCR presents a robust, comprehensive approach to secure, privacy-aware, and incentivised data sharing in the biomedical domain.

Blockchain Revolutionizing in Emergency Medicine: A Scoping Review of Patient Journey through the ED

BACKGROUND

Blockchain technology has revolutionized the healthcare sector, including emergency medicine, by integrating AI, machine learning, and big data, thereby transforming traditional healthcare practices. The increasing utilization and accumulation of personal health data also raises concerns about security and privacy, particularly within emergency medical settings.

METHOD

Our review focused on articles published in databases such as Web of Science, PubMed, and Medline, discussing the revolutionary impact of blockchain technology within the context of the patient journey through the ED.

RESULTS

A total of 33 publications met our inclusion criteria. The findings emphasize that blockchain technology primarily finds its applications in data sharing and documentation. The pre-hospital and post-discharge applications stand out as distinctive features compared to other disciplines. Among various platforms, Ethereum and Hyperledger Fabric emerge as the most frequently utilized options, while Proof of Work (PoW) and Proof of Authority (PoA) stand out as the most commonly employed consensus algorithms in this emergency care domain. The ED journey map and two scenarios are presented, exemplifying the most distinctive applications of emergency medicine, and illustrating the potential of blockchain. Challenges such as interoperability, scalability, security, access control, and cost could potentially arise in emergency medical contexts, depending on the specific scenarios.

CONCLUSION

Our study examines the ongoing research on blockchain technology, highlighting its current influence and potential future advancements in optimizing emergency medical services. This approach empowers frontline medical professionals to validate their practices and recognize the transformative potential of blockchain in emergency medical care, ultimately benefiting both patients and healthcare providers.

Unraveling a blockchain-based framework towards patient empowerment: A scoping review envisioning future smart health technologies

The COVID-19 pandemic shows us how crucial patient empowerment can be in the healthcare ecosystem. Now, we know that scientific advancement, technology integration, and patient empowerment need to be orchestrated to realize future smart health technologies. In that effort, this paper unravels the Good (advantages), Bad (challenges/limitations), and Ugly (lacking patient empowerment) of the blockchain technology integration in the Electronic Health Record (EHR) paradigm in the existing healthcare landscape. Our study addresses four methodically-tailored and patient-centric Research Questions, primarily examining 138 relevant scientific papers. This scoping review also explores how the pervasiveness of blockchain technology can help to empower patients in terms of access, awareness, and control. Finally, this scoping review leverages the insights gleaned from this study and contributes to the body of knowledge by proposing a patient-centric blockchain-based framework. This work will envision orchestrating three essential elements with harmony: scientific advancement (Healthcare and EHR), technology integration (Blockchain Technology), and patient empowerment (access, awareness, and control).

Role of Incentives in the Use of Blockchain-Based Platforms for Sharing Sensitive Health Data: Experimental Study

BACKGROUND

Blockchain is an emerging technology that enables secure and decentralized approaches to reduce technical risks and governance challenges associated with sharing data. Although blockchain-based solutions have been suggested for sharing health information, it is still unclear whether a suitable incentive mechanism (intrinsic or extrinsic) can be identified to encourage individuals to share their sensitive data for research purposes.

OBJECTIVE

This study aimed to investigate how important extrinsic incentives are and what type of incentive is the best option in blockchain-based platforms designed for sharing sensitive health information.

METHODS

In this study, we conducted 3 experiments with 493 individuals to investigate the role of extrinsic incentives (ie, cryptocurrency, money, and recognition) in data sharing with research organizations.

RESULTS

The findings highlight that offering different incentives is insufficient to encourage individuals to use blockchain technology or to change their perceptions about the technology's premise for sharing sensitive health data. The results demonstrate that individuals still attribute serious risks to blockchain-based platforms. Privacy and security concerns, trust issues, lack of knowledge about the technology, lack of public acceptance, and lack of regulations are reported as top risks. In terms of attracting people to use blockchain-based platforms for data sharing in health care, we show that the effects of extrinsic motivations (cryptoincentives, money, and status) are significantly overshadowed by inhibitors to technology use.

CONCLUSIONS

We suggest that before emphasizing the use of various types of extrinsic incentives, the users must be educated about the capabilities and benefits offered by this technology. Thus, an essential first step for shifting from an institution-based data exchange to a patient-centric data exchange (using blockchain) is addressing technology inhibitors to promote patient-driven data access control. This study shows that extrinsic incentives alone are inadequate to change users' perceptions, increase their trust, or encourage them to use technology for sharing health data.

Comprehensive review for healthcare data quality challenges in blockchain technology

There are several features inherent in blockchain, including decentralized storage, distributed ledger, immutability, security and authentication, and it has shifted away from the hype to be used practically in different industries, such as in the healthcare sector. The use of blockchain technology has allowed the provision of improved services to industries. The objective of this paper is to demonstrate how the use of blockchain is influenced by data quality issues in the healthcare industry. The article is structured as a systematic literature review study that uses several articles issued in various databases from 2016 onwards. In this review study, 65 articles were chosen and grouped into a single key aspect of the challenge in the healthcare sector. The findings obtained were analyzed based on factors in three domains, classified as issues pertinent to the adoption, operational and technological domains. This review study aims to use the findings to provide support to the practitioners, stakeholders and professionals, whose purpose is to carry out and manage transformation projects pertinent to blockchain in the field of healthcare. In addition, the organizations would be facilitated in their decision-making processes when the potential blockchain users are made to comprehend the implicit factors related to blockchain.

Medical supply chain integrated with blockchain and IoT to track the logistics of medical products

Nowadays blockchain technology plays a vital role in creative developments and important discoveries in the world. Blockchain develops secure and trustworthy platforms for data sharing in various application areas such as secure sharing of medical data, Anti-money laundering, tracking systems, Supply chain, and logistics monitoring, Crypto-currency exchange, etc. Today's Supply chain in the healthcare sector faces many problems like security, transparency, tampering with medical products, counterfeit drugs, more paperwork, high cost, and more time-consuming process while transporting medical equipment from manufacture to end-users. To overcome these problems, we introduce Novel Approach for Integrated IoT (Internet of Things) With Blockchain in Health Supply Chain (NAIBHSC) approach. By using this approach, we can eliminate all supply chain-related issues between suppliers and end-users. The goal of this research is by combining Blockchain technology with IoT to develop a smart health supply chain management system. This approach provides security, privacy, trust, visibility, decentralized tracking and tracing of the medical product, avoids counterfeit drugs, avoids the damage to medical components, authentication, reduces the cost, and provides the status of the products during the shipment process between manufacturers to end-user. In this approach, we conduct a series of experiments on a different group of users. The experimental results show that compare to existing approaches our proposed NAIBHSC approach gives better response time that is the average Transaction Per Second (TPS) for a group of 500 users is 100 milliseconds, reduces the latency time that is average latency time for 500 users group has 403 milliseconds, and improves the overall performance of the smart health supply chain management system.

Blockchain-based privacy and security preserving in electronic health: a systematic review

In today's world, health and medicine play an undeniable role in human life. Traditional and current Electronic Health Records (EHR) systems that are used to exchange information between medical stakeholders (patients, physicians, insurance companies, pharmaceuticals, medical researchers, etc.) suffer weaknesses in terms of security and privacy due to having centralized architecture. Blockchain technology ensures the privacy and security of EHR systems thanks to the use of encryption. Moreover, due to its decentralized nature, this technology prevents central failure and central attack points. In this paper, a systematic literature review (SLR) is proposed to analyze the existing Blockchain-based approaches for improving privacy and security in electronic health systems. The research methodology, paper selection process, and the search query are explained. 51 papers returned from our search criteria published between 2018 and Dec 2022 are reviewed. The main ideas, type of Blockchain, evaluation metrics, and used tools of each selected paper are discussed in detail. Finally, future research directions, open challenges, and some issues are discussed.

Blockchain-Based Supply Chain Systems, Interoperability Model in a Pharmaceutical Case Study

The main purpose of supply chain systems based on blockchain technology is to take advantage of technology innovations to ensure that a tracked asset's audit trail is immutable. However, the challenge lies in tracking the asset among different blockchain-based supply chain systems. The model proposed in this paper has been designed to overcome the identified challenges. Specifically, the proposed model enables: (1) the asset to be tracked among different blockchain-based supply-chain systems; (2) the tracked asset's supply chain to be cryptographically verified; (3) a tracked asset to be defined in a standardized format; and (4) a tracked asset to be described with several different standardized formats. Thus, the model provides a great advantage in terms of interoperability between different blockchain-driven supply chains over other models in the literature, which will need to replicate the information in each blockchain platform they operate with, while giving flexibility to the platforms that make use of it and maintain the scalability of those logistic platforms. This work aims to examine the application of the proposed model from an operational point of view, in a scenario within the pharmaceutical sector.

Reshaping healthcare supply chain using chain-of-things technology and key lessons experienced from COVID-19 pandemic

The COVID-19 (Corona virus disease 2019) pandemic continues to slash through the entire humanity on the earth causing an international health crisis and financial uncertainty. The pandemic has formed a colossal disruption in supply chain networks. It has caused piling higher mortality in patients with comorbidities and generated a surging demand for critical care equipment, vaccines, pharmaceuticals, and cutting-edge technologies. Personal protective equipment, masks, ventilators, testing kits, and even commodities required for daily care have been scarce as lockdown and social distancing guidelines have kicked in. Amidst COVID-19, implementing and executing key processes of the healthcare supply chain (HSC) in a secured, trusted, effective, universally manageable, and the traceable way is perplexing owing to the fragile nature of the HSC, which is susceptible to redundant efforts and systemic risks that can lead to adverse impacts on consumer health and safety. Though the crisis shone a harsh light on the cracks and weaknesses of the HSC, it brings some significant insights into how HSC can be made more resilient and how healthcare industries figure out solutions to mitigate disruptions. While there are innumerable experiences learned from the disruption of this crisis, in this paper, five important areas to analyze the most vital and immediate HSC enhancements including building a resilient supply chain, thinking localization, implementing reliable reverse logistics, breaking down extant silos to achieve end-to-end visibility, and redesigning HSC using digitalization are emphasized. This work identifies important features related to CoT and HSC. Also, this study links these lessons to a potential solution through Chain of Things (CoT) technology. CoT technology provides a better way to monitor HSC products by integrating the Internet of Things (IoT) with blockchain networks. However, such an integrated solution should not only focus on the required features and aspects but also on the correlation among different features. The major objective of this study is to reveal the influence path of CoT on smart HSC development. Hence, this study exploits (i) fuzzy set theory to eliminate redundant and unrelated features; (ii) the Decision-Making and Experimental Evaluation Laboratory (DEMATEL) method to handle the intricate correlation among different features. This fuzzy-DEMATEL (F-DEMATEL) model attempts to direct CoT technology towards smart HSC by identifying the most influencing factors and investors are recommended to contribute to the development of application systems. This work also demonstrates how CoT can act a vital role in handling the HSC issues triggered by the pandemic now and in the post-COVID-19 world. Also, this work proposes different CoT design patterns for increasing opportunities in the HSC network and applied them as imperative solutions for major challenges related to traditional HSC networks.

Leveraging machine learning and blockchain in E-commerce and beyond: benefits, models, and application

Blockchain technology (BT) allows market participants to keep track of digital transactions without central recordkeeping. The features of blockchain, including decentralization, persistency, and attack resistance, allow data security and privacy. Machine learning (ML) involves the analytical platform on a massive amount of data to provide precise decisions. Since data reliability, integration, and data security are crucial in machine learning, the emergence of blockchain technology and machine learning has become a unique, most disruptive, and trending research in the last few years, achieving comparable and precise performance. The combination of blockchain and machine learning (BT–ML) has been applied across different applications to assist decision-makers in retrieving valuable data insights while preserving privacy and integration. This paper summarizes the state-of-the-art research in combing BT and ML in e-commerce and other various applications, including healthcare, smart transportation, and the Internet of Things (IoT). The challenges and benefits of integrating machine learning and blockchain technologies are outlined in the paper. We also discuss the advantages and limitations of current algorithms in the BT–ML integration. This paper provides a roadmap for researchers to pave the way for current and future research directions in combing the BT and ML research areas.

Sharing Health Information Using a Blockchain

Data sharing in the health sector represents a big problem due to privacy and security issues. Health data have tremendous value for organisations and criminals. The European Commission has classified health data as a unique resource owing to their ability to enable both retrospective and prospective research at a low cost. Similarly, the Organisation for Economic Co-operation and Development (OECD) encourages member nations to create and implement health data governance systems that protect individual privacy while allowing data sharing. This paper proposes adopting a blockchain framework to enable the transparent sharing of medical information among health entities in a secure environment. We develop a laboratory-based prototype using a design science research methodology (DSRM). This approach has its roots in the sciences of engineering and artificial intelligence, and its primary goal is to create relevant artefacts that add value to the fields in which they are used. We adopt a patient-centric approach, according to which a patient is the owner of their data and may allow hospitals and health professionals access to their data.

Information security and privacy in hospitals: a literature mapping and review of research gaps

Information security and privacy are matters of concern in every industry. The healthcare sector has lagged in terms of implementing cybersecurity measures. Therefore, hospitals are more exposed to cyber events due to the criticality of patient data. Currently, little is known about state-of-the-art research on information security and privacy in hospitals. The purpose of this study is to report the outcome of a systematic literature review on research about the application of information security and privacy in hospitals. A systematic literature review following the PRISMA methodology was conducted. To reference our sample according to cybersecurity domains, we benchmarked each article against two cybersecurity frameworks: ISO 27001 Annex A and the NIST framework core. Limited articles in our papers referred to the policies and compliance sections of ISO 27001. In addition, most of our sample is classified by the NIST function "Protect," meaning activities related to identity management, access control and data security. Furthermore, we have identified key domains where research in security and privacy are critical, such as big data, IOT, cloud computing, standards and regulations. The results indicate that although cybersecurity is a growing concern in hospitals, research is still weak in some areas. Considering the recrudescence of cyber-attacks in the healthcare sector, we call for more research in hospitals in managerial and non-technical domains of information security and privacy that are uncovered by our analysis.

Analyzing failures in adoption of smart technologies for medical waste management systems: a type-2 neutrosophic-based approach

Medical waste management (MWM) systems are considered among the most important urban systems nowadays. Cities in different countries prefer to transform their infrastructure based on sustainability guidelines and practices. Meanwhile, smart technologies such as Internet of Things (IoT) and blockchain are being recently used in different urban systems of cities that aim to transform into smart cities. MWM systems are one of the main targets of integrating such smart technologies to maximize economic and social profits and minimize environmental issues. However, the transformation of traditional MWM systems into smart MWM systems and the adoption of such technologies can be a very resource-consuming task. One of the possible tasks in this process can be the identification of factors that cause failure in the adoption of smart technologies. Therefore, this study proposes a multi-criteria evaluation model based on type-2 neutrosophic numbers (T2NNs) to identify factors contributing to failure in the adoption of IoT and blockchain in smart MWM systems in Istanbul, Turkey. Results of the case study indicate that training for different stakeholders, market acceptance, transparency, and professional personnel are the main factors that lead to failure in the adoption of smart technologies. Training for different stakeholders, market acceptance, transparency, and professional personnel factors obtained distance values of 0.494, 0.381, 0.375, and 0.278, respectively, against the best factor which is security and privacy. In order to validate the results of the proposed approach, a sensitivity analysis test is performed. Results of this study can be useful for governmental and private MWM and green companies that are planning to adopt IoT and blockchain within their waste management (WM) system.

Blockchain Framework for Secure COVID-19 Pandemic Data Handling and Protection

COVID-19 pandemic caused global epidemic infections, which is one of the most severe infections in human medical history. In the absence of proper medications and vaccines, handling the pandemic has been challenging for governments and major health facilities. Additionally, tracing COVID-19 cases and handling data generated from the pandemic are also extremely challenging. Data privacy access and collection are also a challenge when handling COVID-19 data. Blockchain technology provides various features such as decentralization, anonymity, cryptographic security, smart contracts, and a distributed framework that allows users and entities to handle COVID-19 data better. Since the outbreak has made the moral crisis in the clinical and administrative centers worse than any other that has resulted in the decline in the supply of the exact information, however, it is vital to provide fast and accurate insight into the situation. As a result of all these concerns, this study emphasizes the need for COVID-19 data processing to acquire aspects such as data security, data integrity, real-time data handling, and data management to provide patients with all benefits from which they had been denied owing to misinformation. Hence, the management of COVID-19 data through the use of the blockchain framework is crucial. Therefore, this paper illustrates how blockchain technology can be implemented in the COVID-19 data handling process. The paper also proposes a framework with three main layers: data collection layer; data access and privacy layer; and data storage layer.

Future of industry 5.0 in society: human-centric solutions, challenges and prospective research areas

Industry 4.0 has been provided for the last 10 years to benefit the industry and the shortcomings; finally, the time for industry 5.0 has arrived. Smart factories are increasing the business productivity; therefore, industry 4.0 has limitations. In this paper, there is a discussion of the industry 5.0 opportunities as well as limitations and the future research prospects. Industry 5.0 is changing paradigm and brings the resolution since it will decrease emphasis on the technology and assume that the potential for progress is based on collaboration among the humans and machines. The industrial revolution is improving customer satisfaction by utilizing personalized products. In modern business with the paid technological developments, industry 5.0 is required for gaining competitive advantages as well as economic growth for the factory. The paper is aimed to analyze the potential applications of industry 5.0. At first, there is a discussion of the definitions of industry 5.0 and advanced technologies required in this industry revolution. There is also discussion of the applications enabled in industry 5.0 like healthcare, supply chain, production in manufacturing, cloud manufacturing, etc. The technologies discussed in this paper are big data analytics, Internet of Things, collaborative robots, Blockchain, digital twins and future 6G systems. The study also included difficulties and issues examined in this paper head to comprehend the issues caused by organizations among the robots and people in the assembly line.

Blockchain technology applications in the health domain: a multivocal literature review

Blockchain technology has been changing the nature of several businesses, from supply chain management to electronic record management systems and copyright management to healthcare applications. It provides a resilient and secure platform for modifications due to its distributed and shared nature and cryptographic functions. Each new technology, however, comes with its challenges alongside its opportunities. Previously, we performed a systematic literature review (SLR) to explore how blockchain technology potentially benefits health domain applications. The previous SLR included 27 formal literature papers from 2016 to 2020. Noticing that blockchain technology is rapidly growing, we extended the previous SLR with a multivocal literature review (MLR) approach to present the state of the art in this study. We focused on understanding to what degree blockchain could answer the challenges inherited in the health domain and whether blockchain technology may bring new challenges to health applications. The MLR consists of 78 sources of formal literature and 23 sources of gray literature from 2016 to 2021. As a result of this study, we specified 17 health domain challenges that can be categorized into four groups: (i) meeting regulatory requirements and public health surveillance, (ii) ensuring security and privacy, (iii) ensuring interoperability, and (iv) preventing waste of resources. The analysis shows that blockchain makes significant contributions to the solutions of these challenges. However, 10 new pitfalls come with adopting the technology in the health domain: the inability to delete sensitive data once it is added to a chain, limited ability to keep large-scale data in a blockchain, and performance issues. The data we extracted during the MLR is available in a publicly accessible online repository.

The Metaverse: A New Challenge for the Healthcare System: A Scoping Review

(1) Background: The metaverse is now a reality, and it interests the scientific community, the educational setting, and medical care. Considering the number of people in front of screens, especially children and adolescents, the metaverse could and should become a place of health promotion. Consequently, the objective of the present study was to review the current literature to detect articles that connected the metaverse with prevention and treatment, education and training, and research setting. (2) Methods: Articles were searched on Pubmed, Web of Science, and Scopus, including English-written papers published until 12 August 2022. They were screened against the eligibility criteria and discussed narratively. (3) Results: The literature published is poor; only 21 articles were included, and 11 of them were added in a second moment. These articles were mainly reviews of the literature or editorials. The aspects related to this virtual world in terms of health prevention and the treatment of clinical conditions, education and training, and research have been narratively discussed. (4) Conclusions: The metaverse could be considered a useful instrument to arrive easily and quickly to the population. Given its importance, today, different studies and investments are required to develop proper health promotion programs that are feasible and valid in the metaverse.

Electronic health records and blockchain interoperability requirements: a scoping review

Objective

The purpose of this study was to conduct a scoping review of publications that explored blockchain technology in the context of interoperability and challenges of electronic health record (EHR) implementations. We synthesize the literature regarding standards and security, specifically regulation, regulatory operability, and conformance to standards. We review open practitioner questions that were not addressed in the studies as directions for further research.

Materials and Methods

We conducted a literature search in the OVID databases (Medline and Embase) on terms blockchain, implementation, interoperability, EHRs, security, and standards. The search resulted in 152 nonduplicate, peer-reviewed manuscripts, of which 15 were relevant to our objective and included for synthesis.

Results

Based on the search results, we analyzed the adoption of blockchain technology in the healthcare systems and challenges to EHR implementation of blockchain. From the synthesized research, we categorized and reported compelling factors of blockchain for EHR integration using current knowledge on blockchain research standardization and architectural challenges.

Discussion

Our research showed promise in implementing blockchain technology associated with EHRs, especially with Health Information Exchanges. The studies relevant for both EHR (n = 5) and blockchain (n = 10) reported compelling factors and limitations of the architecture. Security (n = 4) and interoperability (n = 4) features were reported as compelling requirements with lingering challenges. Standardization literature (n = 3) reported implementation challenges.

Conclusion

This study shows promise in implementing blockchain technology within EHR systems. The adoption is increasing; however, multiple implementation challenges remain from architectural perspectives (eg, scalability and performance), to security challenges (eg, legal requirements), and standard perspectives including patient-matching problems.

A systematic review of digital technology and innovation and its potential to address anti-corruption, transparency, and accountability in the pharmaceutical supply chain

INTRODUCTION

The urgent need to acquire medical supplies amidst the COVID-19 pandemic has led to bypassing of controls that govern the global pharmaceutical supply chain, increasing the risk of corruption. Hence, promoting anti-corruption, transparency, and accountability (ACTA) in supply chain and procurement has never been more important. The adoption of digital tools, if designed and implemented appropriately, can reduce the risks of corruption.

AREAS COVERED

Following PRISMA guidelines, we conducted an interdisciplinary systematic review of health/medicine, humanities/social sciences, engineering, and computer science literature, with the aims of identifying technologies used for pharmaceutical supply chain and procurement optimization and reviewing whether they address ACTA mechanisms to strengthen pharmaceutical governance. Our review identified four distinct categories of digital solutions: e-procurement and open contracting; track-and-trace technology; anti-counterfeiting technology; and blockchain technology.

EXPERT OPINION

Findings demonstrate an increase in research of technologies to improve pharmaceutical supply chain and procurement functions; however, most technologies are not being leveraged to directly address ACTA or global health outcomes. Some blockchain and RFID technologies incorporated ACTA mechanisms and mentioned specific policy/governance frameworks, but more purposeful linkage is needed. Findings point to the need for targeted policy development and governance to activate these innovative technologies to improve global health .

Analysis of critical success factors for blockchain technology implementation in healthcare sector

Purpose

Recently, blockchain technology (BT) has resolved healthcare data management challenges. It helps healthcare providers automate medical records and mining to aid in data sharing and making more accurate diagnoses. This paper attempts to identify the critical success factors (CSFs) for successfully implementing BT in healthcare.

Design/methodology/approach

The paper is methodologically structured in four phases. The first phase leads to identifying success factors by reviewing the extant literature. In the second phase, expert opinions were solicited to authenticate the critical success factors required to implement BT in the healthcare sector. Decision Making Trial and Evaluation Laboratory (DEMATEL) method was employed to find the cause-and-effect relationship among the third phase’s critical success factors. In phase 4, the authors resort to validating the final results and findings.

Findings

Based on the analysis, 21 CSFs were identified and grouped under six dimensions. After applying the DEMATEL technique, nine factors belong to the causal group, and the remaining 12 factors fall under the effect group. The top three influencing factors of blockchain technology implementation in the healthcare ecosystem are data transparency, track and traceability and government support, whereas; implementation cost was the least influential.

Originality/value

This study provides a roadmap and may facilitate healthcare professionals to overcome contemporary challenges with the help of BT.

An Idealized Clinicogenomic Registry to Engage Underrepresented Populations Using Innovative Technology

Current best practices in tumor registries provide a glimpse into a limited time frame over the natural history of disease, usually a narrow window around diagnosis and biopsy. This creates challenges meeting public health and healthcare reimbursement policies that increasingly require robust documentation of long-term clinical trajectories, quality of life, and health economics outcomes. These challenges are amplified for underrepresented minority (URM) and other disadvantaged populations, who tend to view the institution of clinical research with skepticism. Participation gaps leave such populations underrepresented in clinical research and, importantly, in policy decisions about treatment choices and reimbursement, thus further augmenting health, social, and economic disparities. Cloud computing, mobile computing, digital ledgers, tokenization, and artificial intelligence technologies are powerful tools that promise to enhance longitudinal patient engagement across the natural history of disease. These tools also promise to enhance engagement by giving participants agency over their data and addressing a major impediment to research participation. This will only occur if these tools are available for use with all patients. Distributed ledger technologies (specifically blockchain) converge these tools and offer a significant element of trust that can be used to engage URM populations more substantively in clinical research. This is a crucial step toward linking composite cohorts for training and optimization of the artificial intelligence tools for enhancing public health in the future. The parameters of an idealized clinical genomic registry are presented.

Benefits and concerns associated with blockchain-based health information exchange (HIE): a qualitative study from physicians' perspectives

BACKGROUND

Blockchain technology has the potential to revolutionize information sharing in companies. Many studies suggest using blockchain-powered platforms to replace existing mechanisms for health information exchange (HIE) across healthcare organizations. However, very few blockchain-based projects have been implemented in the healthcare sector. This study takes a qualitative approach to explore benefits, concerns, and barriers to the rollout of blockchain in HIE projects from physicians' perspectives.

METHODS

The Promoting Action on Research Implementation in Health Services (PARIHS) framework was used to help us better understand root causes, existing problems, perceived risks, perceived benefits, and suggestions. In-depth interviews have been conducted with 38 physicians in six months. The data were analyzed and coded using NVIVO to classify conceptually similar themes mentioned by the interviewees.

RESULTS

In total, seven themes have been identified. The key benefits are categorized into three themes: innovative technological features, collaborative ecosystem, and system performance. The main concerns and risks are categorized into four themes: individual, organizational, technological, and market-related issues. The findings can contribute to knowledge by highlighting key values expected from blockchain technology in HIEs. The results also explore obstacles to leveraging the blockchain in healthcare from the perspectives of an important stakeholder (physicians).

CONCLUSIONS

The results show that although blockchain technology may create several benefits (e.g., innovative technological features, collaborative ecosystem, and system performance), its applications in healthcare are still in their early stages. The perceptions of the individual issues (e.g., lack of knowledge), organizational issues (e.g., implementation issues), technological issues (e.g., blockchain model types), and market-related issues (e.g., regulatory concerns) indicate that blockchain-based applications in healthcare continue to be an emerging field. This study has practical implications as understanding these concerns can help developers and healthcare managers identify potential issues in the planning, developing, and implementing blockchain-based HIE systems. Addressing these barriers would support the widespread use of blockchain-based HIEs in different healthcare settings and facilitate interoperability and connectivity in regional and community health information networks.

Blockchain technology: A DNN token-based approach in healthcare and COVID-19 to generate extracted data

The healthcare technologies in COVID-19 pandemic had grown immensely in various domains. Blockchain technology is one such turnkey technology, which is transforming the data securely; to store electronic health records (EHRs), develop deep learning algorithms, access the data, process the data between physicians and patients to access the EHRs in the form of distributed ledgers. Blockchain technology is also made to supply the data in the cloud and contact the huge amount of healthcare data, which is difficult and complex to process. As the complexity in the analysis of data is increasing day by day, it has become essential to minimize the risk of data complexity. This paper supports deep neural network (DNN) analysis in healthcare and COVID-19 pandemic and gives the smart contract procedure, to identify the feature extracted data (FED) from the existing data. At the same time, the innovation will be useful to analyse future diseases. The proposed method also analyze the existing diseases which had been reported and it is extremely useful to guide physicians in providing appropriate treatment and save lives. To achieve this, the massive data is integrated using Python scripting language under various libraries to perform a wide range of medical and healthcare functions to infer knowledge that assists in the diagnosis of major diseases such as heart disease, blood cancer, gastric and COVID-19.

Blockchain in radiology research and clinical practice: current trends and future directions

Blockchain usage in healthcare, in radiology, in particular, is at its very early infancy. Only a few research applications have been tested, however, blockchain technology is widely known outside healthcare and widely adopted, especially in Finance, since 2009 at least. Learning by history, radiology is a potential ideal scenario to apply this technology. Blockchain could have the potential to increase radiological data value in both clinical and research settings for the patient digital record, radiological reports, privacy control, quantitative image analysis, cybersecurity, radiomics and artificial intelligence.

Up-to-date experiences using blockchain in radiology are still limited, but radiologists should be aware of the emergence of this technology and follow its next developments. We present here the potentials of some applications of blockchain in radiology.

Design of Optimal Scheduling Model for Emergency Medical Supplies by Blockchain Technology

The study aims to explore the scheduling plan for the emergency of blockchain technology in the medical industry. Network security architecture for medical supplies management based on the Hyperledger Fabric optimized consensus mechanism is established by studying the characteristics of blockchain technology and its data structure composition. The supply chain model for medical device scheduling based on intelligent contracts is selected for the particularity of the nature and shape of medical devices in medical supplies. Ant colony algorithm is used to solve it. Case analysis and verification results show that the improved Hyperledger Fabric consensus mechanism has better security performance. Under the condition of 10,000 transactions, the probability of an attacker with the optimized consensus mechanism successfully controlling the transaction is only 7.2%. The optimized solution is about 50% higher than the original solution in terms of transaction processing speed. Over 1000 transactions, the transaction latency optimization rate is more than doubled. The total order completion time of the medical device scheduling model adopted by the intelligent contract is 26.3% higher than the historical service time of 19 days. The performance of the medical emergency material scheduling program that is added to the supply chain technology is better.

Improved Classification of Blockchain Transactions Using Feature Engineering and Ensemble Learning

Although the blockchain technology is gaining a widespread adoption across multiple sectors, its most popular application is in cryptocurrency. The decentralized and anonymous nature of transactions in a cryptocurrency blockchain has attracted a multitude of participants, and now significant amounts of money are being exchanged by the day. This raises the need of analyzing the blockchain to discover information related to the nature of participants in transactions. This study focuses on the identification for risky and non-risky blocks in a blockchain. In this paper, the proposed approach is to use ensemble learning with or without feature selection using correlation-based feature selection. Ensemble learning yielded good results in the experiments, but class-wise analysis reveals that ensemble learning with feature selection improves even further. After training Machine Learning classifiers on the dataset, we observe an improvement in accuracy of 2–3% and in F-score of 7–8%.

Delivering epilepsy care in low-resource settings: the role of technology

INTRODUCTION

The implementation of technology in the field of epileptology has traditionally focused on its use for diagnosis and treatment and has, unsurprisingly, been capital-intensive, making it therefore mainly implementable in advanced high-income countries. Because of technological innovations over the past 20 years there has been almost a paradigm shift, particularly in access to and the potential for implementing relevant technology in lesser developed environments. Nearly 80% of people living with epilepsy live in low and middle-income countries.

AREAS COVERED

The challenge and the purpose of this paper is to discuss how technology can be implemented into lesser-resourced contexts not only cost-effectively but in a cost-saving way while also building capacity and thus sustainability.

EXPERT OPINION

The rate of technological advancement presents the risk of progressive widening of the technology and care gaps between advanced and lesser developed regions. Implementing technology is both about finding relevant appropriate technologies for the individual contexts of a diverse range of countries but also about repurposing low-tech technologies for application in epilepsy care in these areas. Finally exciting advances such as autonomous driving, digital twinning and robotic surgery will likely transform epilepsy care in several lower-resourced settings in the next 5-10 years.

Applications of Blockchain in the Medical Field: Narrative Review

Background

As a distributed technology, blockchain has attracted increasing attention from stakeholders in the medical industry. Although previous studies have analyzed blockchain applications from the perspectives of technology, business, or patient care, few studies have focused on actual use-case scenarios of blockchain in health care. In particular, the outbreak of COVID-19 has led to some new ideas for the application of blockchain in medical practice.

Objective

This paper aims to provide a systematic review of the current and projected uses of blockchain technology in health care, as well as directions for future research. In addition to the framework structure of blockchain and application scenarios, its integration with other emerging technologies in health care is discussed.

Methods

We searched databases such as PubMed, EMBASE, Scopus, IEEE, and Springer using a combination of terms related to blockchain and health care. Potentially relevant papers were then compared to determine their relevance and reviewed independently for inclusion. Through a literature review, we summarize the key medical scenarios using blockchain technology.

Results

We found a total of 1647 relevant studies, 60 of which were unique studies that were included in this review. These studies report a variety of uses for blockchain and their emphasis differs. According to the different technical characteristics and application scenarios of blockchain, we summarize some medical scenarios closely related to blockchain from the perspective of technical classification. Moreover, potential challenges are mentioned, including the confidentiality of privacy, the efficiency of the system, security issues, and regulatory policy.

Conclusions

Blockchain technology can improve health care services in a decentralized, tamper-proof, transparent, and secure manner. With the development of this technology and its integration with other emerging technologies, blockchain has the potential to offer long-term benefits. Not only can it be a mechanism to secure electronic health records, but blockchain also provides a powerful tool that can empower users to control their own health data, enabling a foolproof health data history and establishing medical responsibility.

Hyperledger blockchain enabled secure medical record management with deep learning-based diagnosis model

In recent times, advanced developments in healthcare sector result in the generation of massive amounts of electronic health records (EHRs). EHR system enables the data owner to control his/her data and share it with designated people. The vast volume of data in the healthcare system makes it difficult for data to ensure security and diagnostic processes. To resolve these issues, this paper develops a new hyperledger blockchain enabled secure medical data management with deep learning (DL)-based diagnosis (HBESDM-DLD) model. The presented model involves distinct stages of operations such as encryption, optimal key generation, hyperledger blockchain-based secure data management, and diagnosis. The presented model allows the user to control access to data, permit the hospital authorities to read/write data, and alert emergency contacts. For encryption, SIMON block cipher technique is applied. At the same time, to improve the efficiency of the SIMON technique, a group teaching optimization algorithm (GTOA) is applied for the optimal key generation of the SIMON technique. Moreover, the sharing of medical data takes place using multi-channel hyperledger blockchain that utilizes a blockchain for storing patient visit data and for the medical institutions to record links for the EHRs saved in external databases. Once the data are decrypted at the receiving end, finally, variational autoencoder (VAE)-based diagnostic model is applied to detect the existence of the diseases. The performance validation of the HBESDM-DLD model takes place on benchmark medical dataset and the results are inspected under various performance measures. The experimental results proves that the HBESDM-DLD methodology is superior to state-of-the-art methods.

A scoping review of global vaccine certificate solutions for COVID-19

Globally, measures, such as lockdown, quarantining, and physical distancing, have been implemented to curb the spread of COVID-19. As the vaccines are now available and reintegration into society is beginning, measures such as vaccine certificates are being implemented around the world. We conducted a scoping review to identify the initial digital solutions for COVID-19 vaccine certificates and evaluate them on the basis of purpose and use case, technological architecture, and ethical and legal implications. Articles identified from a Google search and a search of MEDLINE, Ovid and preprint servers were reviewed in duplicate, and data were extracted using a data extraction form. Data were extracted for date, location, type of article, source, companies identified for creating vaccine certificates, technology used, type of evidence provided (article quoting research study or an expert opinion), digital architecture, security and privacy measures, and use cases. Technology emerged as the most dominant theme followed by ethics, travel, legal concerns, public policy, and scientific concerns. Our review identified eight solutions that are working toward COVID-19 vaccine certificates world-wide, all optimizing blockchain technology. COVID-19 vaccine certificates are being considered in 11 countries and are in place in 5 others. Many issues concerning the themes we identified remain to be addressed to facilitate successful implementation.

Blockchain for genomics and healthcare: a literature review, current status, classification and open issues

The tremendous boost in the next generation sequencing technologies and in the "omics" technologies resulted in the generation of hundreds of gigabytes of data per day. Nowadays, via integrating -omics data with other data types, such as imaging and electronic health record (EHR) data, panomics studies attempt to identify novel and potentially actionable biomarkers for personalized medicine applications. In this respect, for the accurate analysis of -omics data and EHR, there is a need to establish secure and robust pipelines that take the ethical aspects into consideration, regulate privacy and ownership issues, and data sharing. These days, blockchain technology has picked up significant attention in diverse fields, including genomics, since it offers a new solution for these problems from a different perspective. Blockchain is an immutable transaction ledger, which offers secure and distributed system without a central authority. Within the system, each transaction can be expressed with cryptographically signed blocks, and the verification of transactions is performed by the users of the network. In this review, firstly, we aim to highlight the challenges of EHR and genomic data sharing. Secondly, we attempt to answer "Why" or "Why not" the blockchain technology is suitable for genomics and healthcare applications in detail. Thirdly, we elucidate the general blockchain structure based on the Ethereum, which is a more suitable technology for the genomic data sharing platforms. Fourthly, we review current blockchain-based EHR and genomic data sharing platforms, evaluate the advantages and disadvantages of these applications, and classify these applications using different metrics. Finally, we conclude by discussing the open issues and introducing our suggestion on the topic. In summary, to facilitate the diagnosis, monitoring and therapy of diseases with the effective analysis of -omics data with other available data types, through this review, we put forward the possible implications of the blockchain technology to life sciences and healthcare.

Prescription Habits Related to Chronic Pathologies of Elderly People in Primary Care in the Western Part of Romania: Current Practices, International Recommendations, and Future Perspectives Regarding the Overuse and Misuse of Medicines

The European Commission’s 2019 report regarding the state of health profiles highlighted the fact that Romania is among the countries with the lowest life expectancy in the European Union. Therefore, the objectives of the present study were to assess the current prescription habits of general physicians in Romania related to medicines taken by the elderly population for chronic conditions in both urban and rural setting and to discuss/compare these practices with the current international recommendations for the elderly (American—Beers 2019 criteria and European—STOPP/START v.2, 2015 criteria). A total of 2790 electronic prescriptions for chronic pathologies collected from 18 community pharmacies in the western part of Romania (urban and rural zones) were included. All medicines had been prescribed by general physicians. We identified the following situations of medicine overuse: 15% of the analyzed prescriptions involved the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for >2 weeks, 12% involved the use of a proton-pump inhibitor (PPI) for >8 weeks, theophylline was the bronchodilator used as a monotherapy in 3.17% of chronic obstructive pulmonary disease cases, and zopiclone was the hypnotic drug of choice for 2.31% of cases. Regarding the misuse of medicines, 2.33% of analyzed prescriptions contained an angiotensin-converting enzyme (ACE) inhibitor and an angiotensin II receptor blocker (ARB) for patients with renal failure in addition to vitamin K antagonists (AVKs) and NSAIDs in 0.43% of cases. Prescriptions for COX2 NSAIDs for periods longer than 2 weeks for patients with cardiovascular disorders accounted for 1.33% of prescriptions, and trihexyphenidyl was used as a monotherapy for patients with Parkinson’s disease in 0.18% of cases. From the included medical prescriptions, 32.40% (the major percent of 2383 prescriptions) had two potentially inappropriate medications (PIMs). Rural zones were found to be risk factor for PIMs. Decreasing the chronic prescription of NSAIDs and PPIs, discontinuing the use of hypnotic drugs, and avoiding potentially harmful drug–drug associations will have long term beneficial effects for Romanian elderly patients.

An ISM Modeling of Barriers for Blockchain/Distributed Ledger Technology Adoption in Supply Chains towards Cybersecurity

Over the last few years, the increasing level of cyber risks derived from the growing connectedness of Industry 4.0 has led to the emergence of blockchain technology as a major innovation in supply chain cybersecurity. The main purpose of this study is to identify and rank the significant barriers affecting the implementation of blockchain technology as a key component of cyber supply chain risk management (CSCRM). This research relied on the “interpretive structural modeling (ISM)” technique in the structure of a hierarchical model to investigate the contextual relationships of identified challenges for blockchain adoption in CSCRM; it also classifies the influential challenges based on their driving and dependence powers. The results highlight that “cryptocurrency volatility” is the challenge at the top level of the hierarchy, implying weak driving power but it is strongly dependent on the other challenges. “Poor regulatory provisions”, “technology immaturity”, “dependent on input information from external oracles”, “scalability and bandwidth issues”, and “smart contract issues” are significant challenges for the adoption of blockchain in cyber supply chain risk management and are located at the bottom level of the hierarchy with higher driving power. The implications for theory and practice of the research are also highlighted.

BSF-EHR: Blockchain Security Framework for Electronic Health Records of Patients

In the current epoch of smart homes and cities, personal data such as patients’ names, diseases and addresses are often violated. This is frequently associated with the safety of the electronic health records (EHRs) of patients. EHRs have numerous benefits worldwide, but at present, EHR information is subject to considerable security and privacy issues. This paper proposes a way to provide a secure solution to these issues. Previous sophisticated techniques dealing with the protection of EHRs usually make data inaccessible to patients. These techniques struggle to balance data confidentiality, patient demand and constant interaction with provider data. Blockchain technology solves the above problems since it distributes information in a transactional and decentralized manner. The usage of blockchain technology could help the health sector to balance the accessibility and privacy of EHRs. This paper proposes a blockchain security framework (BSF) to effectively and securely store and keep EHRs. It presents a safe and proficient means of acquiring medical information for doctors, patients and insurance agents while protecting the patient’s data. This work aims to examine how our proposed framework meets the security needs of doctors, patients and third parties and how the structure addresses safety and confidentiality concerns in the healthcare sector. Simulation outcomes show that this framework efficiently protects EHR data.